1 >>Which of the following statements about clostridial infections are correct? ?
- (A) Early antibiotic therapy is important after the isolation of clostridia from any wound to prevent more serious disease
- (B) Alpha toxin, a lecithinase, is one of the major clostridial toxins, causes diarrhea.
- (C) Clostridium perfringens is one of the most common causes of food poisoning in the United States.
- (D) The diagnosis of clostridial myonecrosis can be difficult to make because few organisms are present in the skin lesions.
Internal Medicine Objective Questions | Internal Medicine Quiz
2 >>In which of the following patients should an anaerobic organism be considered as a potential etiologic agen ?
- (A) A previously healthy 18-year-old boy with sudden fever, cough, and right lower lobe infiltrate
- (B) A 50-year-old man with alcoholism who has marked cellulitis, swelling, and pain in the left lower mandible
- (C) A 50-year-old woman with diabetes, low-grade fever, malaise, and a swollen and inflamed right pinna (of the ear).
- (D) A 50-year-old woman with fever, hypoxia, and pulmonary infiltrates 4 h after having general anesthesia for a cholecystectomy
3 >>Which statement about varicella-zoster infection is correct? ?
- (A) Once dermatomal herpes zoster develops in a patient, repeated recurrences are the rule
- (B) Encephalopathy is a serious complication of varicella in children.
- (C) Chickenpox is very contagious, with attack rates estimated at between 70 and 90%.
- (D) Varicella pneumonitis, the most serious complication of chickenpox, occurs more frequently in children than in adults
4 >>Which of the following statements accurately describe cytomegalovirus (CMV)? ?
- (A) Approximately 60% of infants who are breast-fed by seropositive mothers become infected; this represents the majority of cases of cytomegalic inclusion disease in newborn infants
- (B) About 10% of newborn infants have asymptomatic CMV infection in the United States; < 1% have symptomatic disease.
- (C) CMV mononucleosis is the most common cause of heterophil-negative mononucleosis.
- (D) CMV pneumonia, a major cause of morbidity and mortality in bone marrow transplant patients, can be diagnosed only by viral cultures of sputum.
5 >>Which statement about viral gastroenteritis caused by rotavirus and Norwalk virus is correct? ?
- (A) Both alter cyclic nucleotide levels and cause a secretory diarrhea
- (B) Norwalk agent is the most important cause of severe diarrhea in infants
- (C) Rotavirus infection can be diagnosed only retrospectively by serologic methods since isolation from stool is very difficult
- (D) Norwalk virus has been associated with both foodborne and waterborne epidemics
6 >>Which of the following statements correctly characterize tetanus? ?
- (A) Neonatal tetanus develops after passage through a contaminated birth canal.
- (B) Human tetanus immune globulin can modify the course of disease significantly once symptoms develop.
- (C) Tetanus does not recur because lasting immunity develops.
- (D) In a patient who is uncertain about his or her immunization status, both tetanus toxoid and immune globulin should be given for serious wounds.
7 >>A 48-year-old man is admitted to the coronary care unit with an acute inferior myocardial infarction. Two hours after admission, his blood pressure is 86/52 mmHg; his heart rate is 40 beats per minute with sinus rhythm. Which of the following would be the most appropriate initial therapy? ?
- (A) Immediate insertion of a temporary transvenous pacemaker
- (B) Intravenous administration of atropine sulfate, 0.6 mg
- (C) Administration of normal saline, 300 mL over 15 min
- (D) Intravenous administration of dobutamine, 0.35 mg/min
8 >>A 68-year-old man with a history of hypertension, diabetes, and urinary retention awoke feeling nauseated and light-headed. He did not respond to questions from his wife. When the emergency medical technicians arrived, his blood pressure was 60 by palpation. IV fluids and oxygen were administered. Vital signs obtained in the ERwere blood pressure 60, heart rate 120 and regular, temperature 38�C (102�F), and respiratory rate 30. A brief physical examination revealed coarse rales approximately halfway up in the chest bilaterally and inaudible heart sounds. An indwelling urinary catheter was placed with drainage of 10 to 20 mL of dark urine. Chest x-ray revealed bilateral interstitial infiltrates; ECG was unremarkable except for sinus tachycardia. Antibiotics were administered, and the patient was transferred to the ICU, where a right heart catheterization was performed. Pulmonary capillary wedge pressure was 28 mmHg. Cardiac output was 1.9 L/min. Right atrial mean pressure was 10 mmHg. The most likely cause of this man’s hypotension wa ?
- (A) left ventricular dysfunction
- (B) right ventricular infarction
- (C) gram-negative sepsis
- (D) gastrointestinal bleeding
9 >>Which of the following statements concerning the use of captopril is true? ?
- (A) Decreases plasma renin activity
- (B) Increases the degradation of circulating bradykinin
- (C) Increases the formation of angiotensin II
- (D) Contraindicated in patients with bilateral renal artery stenosis
10 >>A 55-year-old man with known coronary heart disease develops recurrent anginal symptoms 2 months after undergoing an apparently successful percutaneous transluminal coronary angioplasty (PTCA) procedure. The original PTCA procedure was performed because of angina unresponsive to medical therapy in the setting of two proximal 90% occlusions (one in the right coronary artery and the other in the left circumflex). Cardiac catheterization reveals that the left circumflex lesion has reoccluded. Which of the following statements concerning the patient’s current condition is correct? ?
- (A) The patient probably will require coronary artery bypass surgery
- (B) If the patient had been treated with aspirin daily from the time of his initial PTCA, this problem would have been less likely
- (C) A cholesterol-lowering agent would have been useful in preventing this problem
- (D) Coronary artery smooth-muscle hyperplasia probably played a role in the current problem
11 >>A 67-year-old man who has experienced recurrent episodes of dizziness over the last several months is admitted to the hospital because of a fainting episode. No evidence of acute myocardial infarction is documented. On the evening of admission, the patient tells his nurse that approximately 10 min earlier he experienced several minutes of dizziness. His current rhythm appears to be normal sinus; however, a monitoring strip obtained at the time of this episode reveals absent QRS complexes every third beat. The PRinterval, while slightly prolonged, is constant from beat to beat. P waves are present at regular intervals. Which of the following is the most appropriate therapeutic action? ?
- (A) Insertion of permanent cardiac pacemaker
- (B) Insertion of temporary cardiac pacemaker followed by insertion of permanent cardiac pacemaker
- (C) Administration of atropine, 2 mg IV
- (D) Administration of isoproterenol, 2 mg/min IV
12 >>A 53-year-old man presents to the emergency room after the acute onset of chest pain. The episode occurred 8 h prior to his arrival and lasted for a total of 20 to 30 min. The chest pain is now resolved. The patient has a long history of diabetes mellitus and hypocholesteremia and has smoked approximately 1 to 1 1/2 packs per day of cigarettes for the past 30 years. On physical exam he has a blood pressure of 84/52, and his pulse is 54. He has jugular venous distention to the angle of the mandible and clear lung fields. His rhythm strip reveals a Wenkebach pattern. Given his hypotension, a Swan-Ganz catheter is placed. Right atrial pressure is estimated at 16 mmHg (normal 0- 5), pulmonary artery pressure at 20/10 mmHg (normal 12- 28/3- 13), and the pulmonary capillary wedge pressure is 8 mmHg (normal range 3- 10). Which of the following is most consistent with this clinical picture? ?
- (A) An anterior wall myocardial infarction
- (B) A right ventricular infarction
- (C) A ruptured mitral valve leaflet
- (D) A constrictive pericarditis following a myocardial infarction
13 >>Examination of the carotid pulse reveals two impulses or peaks during ventricular systole. Which of the following physical findings probably would be associated with this finding? ?
- (A) Diastolic murmur beginning after an opening snap
- (B) Decrease in systolic arterial pressure during inspiration
- (C) Systolic murmur increasing during the Valsalva maneuver
- (D) Right-sided third heart sound
14 >>A 65-year-old man with a long history of untreated hypertension complains of recurrent shortness of breath on minimal exertion. Examination of the cardiovascular system is normal except for a prominent precordial impulse. Chest x-ray is normal except for a prominent left ventricular shadow. An exercise tolerance test with thallium scanning reveals no evidence of myocardial ischemia. Two-dimensional echocardiography reveals left ventricular hypertrophy. Radionuclide ventriculography reveals normal right and left ventricular ejection fractions. What is the most likely explanation for the patient’s symptoms ?
- (A) Chronic obstructive pulmonary disease
- (B) Reactive airways disease
- (C) Systolic congestive heart failure
- (D) Diastolic congestive heart failure
15 >>Clues to the presence of atrioventricular nodal block (as opposed to trifascicular block) include which of the following? ?
- (A) Clinical evidence of inferior myocardial infarction
- (B) No change in the escape rhythm with exercise
- (C) An escape-focus rate slower than 40 beats per minute
- (D) A widened QRS complex at the escape focus
16 >>Which of the following agents has been shown to reduce mortality in patients with congestive heart failure? ?
- (A) Digitalis
- (B) Furosemide
- (C) Enalapril
- (D) Procainamide
17 >>A 68-year-old Haitian man presents with a chronic nonproductive cough, dyspnea on exertion, and chronic nonexertional chest pain. The patient notes a loss of 10 pounds over the past 6 months, decreased appetite, and swelling of the ankles. Physical findings reveal an ill-appearing man with decreased skeletal mass. Blood pressure is 100/70 without a significant inspiratory decrease in systolic pressure. Heart rate is 110; respiratory rate is 25; temperature is 37.2�C (99.0�F) orally. Significant physical findings include the absence of rales on chest examination and the presence of jugular venous distention with a decline during inspiration. The apical cardiac pulse is reduced. The heart sounds are distant; an early third heart sound occurs very shortly after aortic valve closure; there are no murmurs. Both the liver and the spleen are enlarged, and there is a fluid wave on abdominal examination. Electrocardiography displays low QRS voltage but is otherwise unremarkable. Chest x-ray reveals clear lungs and an enlarged cardiac silhoutte. Which of the following findings is most likely to appear on echocardiographic examination? ?
- (A) Enlarged right ventricular size
- (B) Pericardial effusion
- (C) Thickened myocardium
- (D) Thickened pericardium
18 >>Each of the following patients was noted to have an abnormally high serum cholesterol and was placed on a reduced calorie, cholesterol, and fat diet for the past 3 months. None has any history of ischemic heart disease. In which of the following patients would it be most appropriate to recommend lipid-lowering drug therapy at this time? ?
- (A) A 52-year-old smoker and diabetic with an LDL cholesterol value of 3.2 mmol/L (120 mg/dL)
- (B) A 60-year-old hypertensive woman with an LDL cholesterol value of 3.5 mmol/L (140 mg/dL)
- (C) A 50-year-old man with cholesterol of 6 mmol/L (230 mg/dL)
- (D) A 45-year-old man with LDL cholesterol of 5 mmol/L (200 mg/dL)
19 >>Which of the following statements regarding secundum atrial septal defect is true? ?
- (A) Surgical correction is advisable when the pulmonary-to-systemic flow ratio has reached 2.0
- (B) Affected persons are usually symptomatic in childhood
- (C) Electrocardiography shows a leftward axis
- (D) Echocardiography shows a normal ventricular septal motion
20 >>A 75-year-old man presents with recurrent episodes of shortness of breath on minimal exertion. He has no prior significant past medical history. Physical examination reveals blood pressure of 110/70 without pulsus paradoxus, heart rate of 110, respiratory rate of 25, and temperature of 37�C (98.6�F) orally. Jugular veins are distended and the heart sounds are distant, but there are third and fourth extra heart sounds. The liver is enlarged, and pedal edema is present. The electrocardiogram shows nonspecific ST-T wave changes and occasional premature ventricular contractions. The chest x-ray reveals clear lung fields and a mildly dilated cardiac silhouette. Echocardiography reveals normal systolic function and thickened ventricular walls with a “speckled” appearance. Which of the following conditions is most consistent with the patient’s clinical presentation? ?
- (A) Alcoholic cardiomyopathy
- (B) Hemochromatosis
- (C) Amyloidosis
- (D) Viral myocarditis
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